Connecticut Higher Education Trust - aboutchet.com

1 Connecticut Higher Education Trust Rollover Form for New or Existing Accounts Use this form to rollover existing 529 Plan funds into CHET Questions? Call toll-free 1-888-799-CHET (1-888-799-2438) Box 150499, Hartford, CT 06115-0499 Visit Please read the Program Disclosure Booklet and Participation Agreement (contained in the Program Disclosure Booklet) for complete rollover information before completing this form. Your rollover proceeds will be invested according to the allocation instructions you provide in section 3 below. For new Accounts, the Program will follow the allocation instructions on the application you submit with this form.

2 Complete a separate form for each rollover account and submit a new Account Application along with this form, unless you already have a Program Account for this Beneficiary. Complete all sections in blue or black ink and print in capital letters. Be sure to sign and date this form. A signature Validation Program Stamp or Medallion signature Guarantee may be required as described in section Please see the Important Information box at the end of this form for additional instructions. 1 Account Information - - Program Account Number (Please complete one form for each Account) Telephone Number Account Owner or Custodian Name (First, MI, Last, Suffix) or Entity Name Account Owner Email Address Beneficiary Name (First, MI, Last, Suffix) 2 Type of Rollover (Check only one box.)

3 Who is the Beneficiary? Same Beneficiary New Beneficiary, excluding UGMA/UTMA Direct Rollover from another qualified tuition program (QTP) We will request a transfer of funds on your behalf directly from your current qualified tuition program account into your Program Account. Please verify whether your current qualified tuition program account has any additional requirements before sending this form to the Program. Indirect Rollover from another qualified tuition program (QTP) or a Coverdell Education Savings Account (Coverdell ESA) Your check must be payable to the Connecticut Higher Education Trust Savings Program and must be received by the Program within 60 days of the date of withdrawal from the other qualified tuition program or Coverdell ESA account to qualify for rollover treatment.

4 3 Allocation Instructions (Check one box) Use my current allocation instructions on file for future contributions. Establish or change my allocation instructions as indicated below for my future contributions. Use a whole percentage next to each Investment Option below. The TOTAL of all allocations must equal 100%. The Program will apply these allocation instructions to future Automatic Contribution Plan (ACP) contributions. These allocation instructions will not apply to payroll deduction contributions, if any. You can change your Allocation Instructions online, by telephone or by form at any time.

5 Investment Option Name (Investment Option Code) Whole Percentage (per Investment Option) Check if new Investment Option2 Moderate Managed Allocation Option (Age based) % New Option Aggressive Managed Allocation Option (Age based) % New Option Conservative Managed Allocation Option (Age based) % New Option 1 signature Validation Program (SVP) Stamps and Medallion signature Guarantees are available from banks or Trust companies, savings banks, savings and loan associations or members of a national stock exchange, and warrants that the signer is the appropriate person to provide instruction.

6 A notary public cannot provide a signature Validation Program (SVP) Stamp or a Medallion signature Guarantee. Please contact your bank or broker, if needed. 2 If a new Investment Option is opened, a different option number will be assigned. Investment Option Name (Investment Option Code) Whole Percentage (per Investment Option) Check if new Investment Option2 Active Global Equity Option (2282) % New Option High Equity Balanced Option (1955) % New Option Global Equity Index Option (2251) % New Option Social Choice Equity Option (2260) % New Option Active fixed income Option (2253) % New Option Index fixed income Option (2281) % New Option principal Plus Interest Option (1956) % New Option Equity Index Option (2304)

7 % New Option International Equity Index Option (2305) % New Option Global Tactical Asset Allocation Option (2306) % New Option Money Market Option (2261) % New Option TOTAL 100% Note: If you allocate your contributions to the principal Plus Interest Option, transfers made at a later date from the principal Plus Interest Option to the Money Market Option will not be permitted. 4 Your Current 529 Plan Account Information The Account Owner name and Social Security number or Individual Taxpayer ID Number must be the same on the account from which you are transferring assets as on your Connecticut Higher Education Trust Savings Plan Account.

8 Type of Account: (Check only one.) Individual Custodial (UGMA/UTMA) Entity - - Account Number (This is the Account from which you are transferring assets.) Account Owner Social Security or Taxpayer Identification Number Account Owner Name (First, MI, Last, Suffix or Name of Entity) Beneficiary Name (First, MI, Last, Suffix) 5 Name and Address of your Current 529 Plan Current Qualified Tuition Program Name Mailing Address Line 1 Mailing Address Line 2 City, State, Zip 2 If a new Investment Option is opened, a different option number will be assigned.

9 6 Instructions to your Current 529 Plan To my current Qualified Tuition Program: Please roll over the assets from my account(s) as requested below and mail a check to the Connecticut Higher Education Trust . Enclose a breakdown of the principal and earnings portion of the distribution with the check. (Check only one box) Roll over the ENTIRE balance in my account. (Estimated Amount: $ _____) OR Roll over a PARTIAL balance in my account, as indicated Option(s) Rollover Amount(s) 1. $ 2. $ 3. $ 4. $ 7 signature and Authorization (Account Owner, Custodian or Authorized Representative of Entity must sign here.)

10 By signing below, I certify the following: I have read the Program Disclosure Booklet and I understand the rules and regulations governing rollover contributions for 529 plan accounts,including that IRS regulations permit only one such rollover for the same beneficiary in a 12-month period. If this rollover represents a change of beneficiary, I certify that the new Beneficiary is a member of the family of the current Beneficiary, asdefined in Section 529 of the Internal Revenue certify that I am the Account Owner, or I have the authority to act as the Account Owner.